Journal of Gastroenterology

, Volume 43, Issue 11, pp 881–888 | Cite as

Is the prognosis of young patients with hepatocellular carcinoma poorer than the prognosis of older patients? A comparative analysis of clinical characteristics, prognostic features, and survival outcome

  • Pik-Eu Chang
  • Wai-Choung Ong
  • Hock-Foong Lui
  • Chee-Kiat Tan
Liver, Pancreas, and Biliary Tract



Hepatocellular carcinoma (HCC) is uncommon in young adults. This study examined the clinical characteristics and survival outcome of young HCC patients compared with those in older patients.


Data were prospectively collected from 638 patients diagnosed with HCC over a 9-year period. Patients aged ≤40 years at diagnosis of HCC were defined as young HCC patients. Their clinical characteristics and survival was compared with those aged >40 years.


The prevalence of young HCC was 8.6% (55/638). Young HCC patients had a significantly higher rate of hepatitis B-related disease (HBsAg positivity: 85.5% vs. 59.7%, P = 0.003), better Child-Pugh status (Child-Pugh class A: 69.1% vs. 43.9%, P = 0.002), and lower rates of cirrhosis (12.7% vs. 34.3%, P = 0.001) compared with the older group. They had more advanced disease at diagnosis, with higher α-fetoprotein levels (>12 000 μg/l: 45.4% vs. 30.5%, P = 0.026), a higher incidence of portal vein involvement (63.6% vs. 40%, P = 0.003), and a more advanced TNM stage (TNM IV: 83.6% vs. 66.4%, P = 0.018). More young patients were eligible for surgical resection (18.2% vs. 8.2%, P = 0.014). The overall survival between the two groups was similar, but when the patients were stratified for stage of disease, the median survival of young patients with early disease was superior to that of older patients (51.2 vs. 11.6 months, P = 0.025).


HCC in young adults occurs mainly in hepatitis B carriers and is often diagnosed at an advanced stage. Their survival outcome is not different from that of older patients because the advanced disease at presentation offsets the advantages of better liver function and a higher resection rate. However, there is a distinct survival advantage for young patients diagnosed with early disease. These results support the importance of extending HCC surveillance to young hepatitis B carriers.

Key words

hepatocellular carcinoma young old prognosis survival 


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  1. 1.
    Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol 2001;2:533–543.PubMedCrossRefGoogle Scholar
  2. 2.
    Seow A, Koh WP, Chia KS, Shi LM, Lee HP, Shanmugaratnam K. Trends in cancer incidence in Singapore 1968–2002, Singapore Cancer Registry Report No. 6.Google Scholar
  3. 3.
    Bosch FX, Ribes J, Borras J. Epidemiology of primary liver cancer. Semin Liver Dis 1999;19:271–285.PubMedCrossRefGoogle Scholar
  4. 4.
    Kew MC, Rossouw E, Hodkinson J, Paterson A, Dusheiko GM, Whitcutt JM. Hepatitis B virus status of South African blacks with hepatocellular carcinoma: comparison between rural and urban patients. Hepatology 1983;3:65–68.PubMedGoogle Scholar
  5. 5.
    Namieno T, Kawata A, Sato N, Kondo Y, Uchino J. Age-related, different clinicopathologic features of hepatocellular carcinoma patients. Ann Surg 1995;221:308–314.PubMedCrossRefGoogle Scholar
  6. 6.
    Falkson G, Cnaan A, Schutt AJ, Ryan LM, Falkson HC. Prognostic factors for survival in hepatocellular carcinoma. Cancer Res 1998;48:7314–7318.Google Scholar
  7. 7.
    Ni YH, Chang MH, Hsu HY, Hsu HC, Chen CC, Chen WJ, et al. Hepatocellular carcinoma in childhood. Clinical manifestations and prognosis. Cancer 1991;68:1737–1741.PubMedCrossRefGoogle Scholar
  8. 8.
    Cho SJ, Yoon JH, Hwang SS, Lee HS. Do young hepatocellular carcinoma patients with relatively good liver function have poorer outcomes than elderly patients? J Gastroenterol Hepatol 2007;22:1226–1231.PubMedCrossRefGoogle Scholar
  9. 9.
    Chen CH, Chang TT, Cheng KS, Su WW, Yang SS, Lin HH, et al. Do young hepatocellular carcinoma patients have a worse prognosis? The paradox of age as a prognostic factor in the survival of hepatocellular carcinoma patients. Liver Int 2006;26:766–773.PubMedCrossRefGoogle Scholar
  10. 10.
    Ng IO, Ng MM, Lai EC, Fan ST. Pathologic features and patient survival in hepatocellular carcinoma in relation to age. J Surg Oncol 1996;61:134–137.PubMedCrossRefGoogle Scholar
  11. 11.
    Lam CM, Chan AO, Ho P, Ng IO, Lo CM, Liu CL, et al. Different presentation of hepatitis B-related hepatocellular carcinoma in a cohort of 1863 young and old patients—implications for screening. Aliment Pharmacol Ther 2004;19:771–777.PubMedCrossRefGoogle Scholar
  12. 12.
    Beasley RP, Hwang LY, Lin CC, Chien CS. Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan. Lancet 1981;2:1129–1133.PubMedCrossRefGoogle Scholar
  13. 13.
    Oka H, Kurioka N, Kim K, Kanno T, Kuroki T, Mizoguchi Y, et al. Prospective study of early detection of hepatocellular carcinoma in patients with cirrhosis. Hepatology 1990;12:680–687.PubMedCrossRefGoogle Scholar
  14. 14.
    Zhang BH, Yang BH, Tang ZY. Randomized controlled trial for screening of hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130:417–422.PubMedGoogle Scholar
  15. 15.
    Wong LL, Limm WM, Severino R, Wong LM. Improved survival with screening for hepatocellular carcinoma. Liver Transpl 2000;6:320–325.PubMedCrossRefGoogle Scholar
  16. 16.
    Beasley RP. Hepatitis B virus. The major etiology of hepatocellular carcinoma. Cancer 1988;61:1942–1956.PubMedCrossRefGoogle Scholar
  17. 17.
    Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Christensen E, et al. Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conference. J Hepatol 2001;35:421–430.PubMedCrossRefGoogle Scholar
  18. 18.
    Bruix J, Sherman M. AASLD Practice guideline: management of hepatocellular carcinoma. Hepatology 2005;42:1208–1236.PubMedCrossRefGoogle Scholar
  19. 19.
    Aramaki M, Kawano K, Sasaki A, Ohno T, Tahara K, Kai S, et al. Hepatocellular carcinoma in young adults. Hepatogastroenterology 2005;52:1795–1797.PubMedGoogle Scholar
  20. 20.
    Klein WM, Molmenti EP, Colombani PM. Primary liver carcinoma arising in people younger than 30 years. Am J Clin Pathol 2005;124:512–518.PubMedCrossRefGoogle Scholar
  21. 21.
    Hernandez-Castillo E, Mondragon-Sanchez R, Garduno-Lopez AL, Gomez-Gomez E, Ruiz-Molina JM, Onate-Ocana LF, et al. Hepatocellular carcinoma in the youth. A comparative analysis with hepatocellular carcinoma in adulthood. Hepatogastroenterology 2005;52:903–907.PubMedGoogle Scholar
  22. 22.
    Sezaki H, Kobayashi M, Hosaka T, Someya T, Akuta N, Suzuki F, et al. Hepatocellular carcinoma in noncirrhotic young adult patients with chronic hepatitis B viral infection. J Gastroenterol 2004;39:550–556.PubMedCrossRefGoogle Scholar
  23. 23.
    Yamazaki Y, Kakizaki S, Sohara N, Sato K, Takagi H, Arai H, et al. Hepatocellular carcinoma in young adults: the clinical characteristics, prognosis and findings of a patient survival analysis. Dig Dis Sci 2007;52:1103–1107.PubMedCrossRefGoogle Scholar
  24. 24.
    Kim JH, Choi MS, Lee H, Kim DY, Lee JH, Koh KC, et al. Clinical features and prognosis of hepatocellular carcinoma in young patients from a hepatitis B-endemic area. J Gastroenterol Hepatol 2006;21:588–594.PubMedCrossRefGoogle Scholar
  25. 25.
    Wan J, Grossman HB. Bladder carcinoma in patients age 40 years or younger. Cancer 1989;64:178–181.PubMedCrossRefGoogle Scholar
  26. 26.
    Shaha AR, Shah JP, Loree TR. Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Oncol 1996;3:534–538.PubMedCrossRefGoogle Scholar
  27. 27.
    Leff DR, Chen A, Roberts D, Grant K, Western C, Windsor AC, et al. Colorectal cancer in the young patient. Am Surg 2007;73:42–47.PubMedGoogle Scholar
  28. 28.
    Adami HO, Malker B, Holmberg L, Persson I, Stone B. The relation between survival and age at diagnosis in breast cancer. N Engl J Med 1986;315:559–563.PubMedCrossRefGoogle Scholar
  29. 29.
    Katai H, Sasako M, Sano T, Maruyama K. Gastric carcinoma in young adults. Jpn J Clin Oncol 1996;26:139–143.PubMedGoogle Scholar
  30. 30.
    Lai IR, Lee WJ, Chen CN, Lee PH, Chang KJ, Chang-Yu S, et al. Gastric cancer in the young. Hepatogastroenterology 1997;44:1641–1645.PubMedGoogle Scholar
  31. 31.
    Bosch FX, Ribes J, Diaz M, Cleries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology 2004;127:S5–S16.PubMedCrossRefGoogle Scholar
  32. 32.
    Feitelson MA, Duan LX. Hepatitis B virus X antigen in the pathogenesis of chronic infections and the development of hepatocellular carcinoma. Am J Pathol 1997;150:1141–1157.PubMedGoogle Scholar
  33. 33.
    Yang HI, Lu SN, Liaw YF, You SL, Sun CA, Wang LY, et al. Hepatitis B e antigen and the risk of hepatocellular carcinoma. N Eng J Med 2002;347:168–174.CrossRefGoogle Scholar
  34. 34.
    Evans AA, Chen G, Ross EA, Shen FM, Lin WY, London WT. Eight year follow-up of the 90,000 person Haimen City cohort: hepatocellular carcinoma mortality, risk factors and gender differences. Cancer Epidemiol Biomarkers Prev 2002;11:369–376.PubMedGoogle Scholar
  35. 35.
    Huo TI, Wu JC, Lee PC, Chau GY, Lui WY, Tsay SH, et al. Seroclearance of hepatitis B surface antigen in chronic carriers does not necessarily imply a good prognosis. Hepatology 1998;28:231–236.PubMedCrossRefGoogle Scholar
  36. 36.
    Yuen MF, Wong DK, Sablon E, Tse E, Ng IO, Yuan HJ, et al. HBsAg seroclearance in chronic hepatitis B in the Chinese: virological, histological and clinical aspects. Hepatology 2004;39:1694–1701.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Pik-Eu Chang
    • 1
  • Wai-Choung Ong
    • 1
  • Hock-Foong Lui
    • 1
  • Chee-Kiat Tan
    • 1
  1. 1.Department of Gastroenterology and HepatologySingapore General HospitalSingaporeSingapore

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